Clinical Review Nurse - New York, NY

VillageCare is seeking a self-motivated RN Utilization Review Nurse for Full-Time position in hybrid model from home within New York Tri-State Area. · Reviews planned health care services to ensure medical necessity and effectiveness according to evidence-based criteria. · Freque ...

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

+ Clinical Review Nurse + · You could be the one who changes everything for our members as a clinical professional on our Medical Management/Health Services team. · + + Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of ca ...

We are looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions tha ...

VillageCare está buscando un RN autónomo y apasionado para el puesto de Utilización Revisora en una posición a tiempo completo. · ...

+You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibilit ...

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

The Utilization Review Nurse processes prospective concurrent retrospective UM medical requests while ensuring compliance with SPD time frames clinical policies operational workflows. · Process prospective concurrent retrospective UM medical requests · Maintain monitor review the ...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.Clinical Review Nurses analyzes all prior authorization requests to determine medical necessity of service and appropriate level of car ...

This position involves processing prospective, concurrent, retrospective Utilization Management medical requests while ensuring compliance with clinical policies and operational workflows. · Maintain appropriate documentation of all services in keeping with all confidentiality an ...

We are looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home. · Reviews planned, in process, or completed health care services to ensure medical necessity and ...

The Utilization Review Nurse will assess member needs and identify solutions to promote high-quality health care services. · ...

You could be the one who changes everything for our members as a clinical professional on our Medical Management/Health Services team. · ...

You could be the one who changes everything for our members as a clinical professional on our Medical Management/Health Services team. · Clinical Review Nurse must have an active New York State nursing license to analyze prior authorization requests to determine medical necessity ...

This is the role of Utilization Review Nurse I at Centene Corporation. · ...

The Department of Case Management at SUNY Downstate Health Sciences University is seeking a full-time TH Utilization Review & Quality Assurance Senior Coordinator / Utilization Review Nurse. · The successful candidate will: · Report directly to the RN Case Management Manager.Revi ...

SUNY Downstate Health Sciences University is seeking a full-time Utilization Review & Quality Assurance Senior Coordinator / Utilization Review Nurse. The Utilization Review (UR) Nurse performs clinical reviews to determine the medical necessity of hospital admissions and continu ...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. · Evaluating patient care cases per hour and collaborating with doctors. · ...

Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. · Insight Global is looking for Utilization Review Registered Nurse to sit remotely with one of their large health insuranc ...

Lensa promotes jobs on LinkedIn on behalf of its direct clients. Insight Global is looking for a Utilization Review Registered Nurse to sit remotely with one of their large health insurance clients. · ...